We invited 15 college student-athletes to review the content of the 5-factor, item AMES. Followed this procedure, we recruited convenient sample of college student-athletes to examine the basic psychometric properties of the 5-factor, item AMES. The 15 college student-athletes reported that the 5-factor, item AMES is very straightforward, no ambiguous and abstract words, no double-barreled items, and no difficulties to read the contents.
They can completely understand the contents of 5-factor, item AMES. Further, a preliminary item discrimination analysis found that the mean of all items were between 2. Also, there is a significant difference between high and low scores on all 58 items. Independent t -tests demonstrated that all 58 items exceeded the critical value of 4 Kline, Therefore, the item discrimination is established.
Thus, the pilot study suggested that 5-factor, item AMES was suitable for further study. We adopted Williams et al. They had been participating in a variety of individual sports, such as golf, weight-lifting, archery, track and field, gymnastics, baseball, taekwondo, badminton; and team sports such as basketball, and volleyball with 6.
They trained an average of 3.
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The procedures were the same as Study 2. Those interested in this study then signed informed consent forms and completed a survey package including a demographic questionnaire and 5-factor, item AMES. The measures included the following:. Demographic questionnaire. The demographic questionnaire was designed to collect participants' age, gender, types of sports, and years of athletic experience.
The contents, factors, rating scale, and sample questions as in Study 2. We screened all data by examining means, standard deviations, skewness, kurtosis, and outliers to make sure there were no abnormal data. Then, we performed an item analysis to examine whether there is a significant difference between high and low scores on all items. Following item analysis, we used Pearson product-moment correlation analysis to examine the relationships of all items.
Last we used Pearson product-moment correlation analysis to examine the relationships of factors extracted. Statistical Package for the Social Sciences version Results indicated no outliers, the mean of all items were between 2. Item discrimination was calculated by comparing the items that were higher than one SD from the mean and items lower than one SD.
We used the principal axes analysis method and oblique rotation to examine the underlying structure of the initial questionnaire because it is suggested that when the factors of a measure are conceptually correlated the oblique rotation is appropriate Gorsuch, , p. With EFA parameters set at five factors and factor loadings exceeding 0. However, some items were either cross-factor loaded or selected into the wrong factors.
We deleted these items and conducted a second round of EFA. Results revealed a 6-factor solution with 25 items accounting for The tireless factor was a new factor that was not found in Study 2. A pilot study found participants can easily understand the contents of the 5-factor, item AMES. Therefore, the content validity of the 5-factor, item AMES was established. Further, a preliminary examination found that the 5-factor, item AMES had significant discriminant indices on all items which indicated that the item AMES can differentiate high vs. The correlation matrix also found all items correlation coefficients exceed 0.
Further, we adopted Worthington and Whittaker, , p. Study 3 achieved the initial goal of gaining a basic tool for assessing AME in sports. However, there is a lack of other psychometric evidence such as the consistency of the factorial structure and criterion validity of the 6-factor, item AMES.
Therefore, further study is needed. The purpose of Study 4 was to confirm the factor structure of the 6-factor, item AMES by Confirmatory Factor Analysis CFA and examine nomological validity by examining the relationships among AMES subscales, positive state of mind, college student-athletes' life stress, and burnout. The procedures were the same as Study 2 and 3. Those interested in this study then signed informed consent forms and completed a survey package including a demographic questionnaire, 6-factor, item AMES, positive state of mind, college student-athletes' life stress scale, and burnout as follow:.
Athlete Burnout ABQ. ABQ Raedeke and Smith, is a self-reported inventory that assesses athletes' burnout experiences. Raedeke and Smith reported that ABQ has three subscales including a the reduced sense of athletic accomplishment, b perceived emotional and physical exhaustion, and, c the devaluation of sports participation. To evaluate athletic burnout experiences participants were asked to answer the questions of ABQ in a 6-point Likert scale that ranged from 1 never to 6 always.
There are eight factors in the item CSALSS including: a sports injury, b performance demand, c coach relationships, d training adaptation, e interpersonal relationships, f romantic relationships, g family relationships, and h academic requirements. Lu and colleagues Lu et al. Participants indicated the frequency of the event on a 6-point Likert scale ranging from 1 Never to 6 Always.
Chang and Lu adapted the original six items of PSOM by replacing the statement of the item's stem into sports-specific questions and providing preliminary reliability and validity through item analysis, EFA, and CFA. These six major elements include attentional focus, productivity, maintaining responsibility, restful repose, and sensual pleasure. We screened all data as described in study 3. The univariate normality examination found no outliers and the mean of all items were between 5.
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The factor loadings for the 18 items ranged from 0. The composite reliability Fornell and Larcker, for each subscale was calculated: vigor 0. The average variance extracted was also calculated: vigor 0. Further, as Table 5 showed AME positively correlated with the positive state of mind but negatively correlated with athlete burnout and life stress which evidenced the nomological validity.
Thus, this indicated that 6-factor, item AMES shows discriminant validity. The purpose of study 4 was to confirm the factor structure of the 6-factor, item AMES from Study 3 and examine concurrent and discriminant validity by examining the relationships among AMES subscales, positive state of mind, college student-athletes' life stress scale, and burnout.
By sampling university athletes and administering the 6-factor, item AMES, CFA analysis found that the measurement model of the 6-factor, item AMES was satisfactory according to related indices. Further, bivariate correlations found AME positively correlated with the positive state of mind but negatively correlated with athlete burnout and life stress which provided nomological validity. Through these stages, it seemed that the 6-factor, item AMES shows adequate factorial structure, nomological validity, discriminant validity, and reliability.
However, the construct validity used test scores and criterion scores at the same time. It is suggested that examining the test scores and criterion scores at a later time would provide evidence of predictive validity American Educational Research Association, American Psychological, Association, and National Council on Measurement in Education, , p. Also, it is suggested that a well-developed measurement should present measurement invariance so it can indicate that the same construct is being measured across some specified groups Widaman et al.
Hence, the predictive validity of 6-factor, item AMES, and its measurement invariance are needed. The purpose of study 5 was to examine measurement invariance of the 6-factor, item AMES across Malaysian and Taiwanese samples. We used AMOS version 22 to perform a measurement invariance. We adopted earlier suggestion Barbosa-Leiker et al.
We will discuss this later in the discussion. Table 7. Therefore, it means that the same level of measurement error for each item between Malaysian and Taiwanese is not the same. However, Lee suggested that most research that using CFA focus on the equivalence of the factor loadings and factorial covariance. If these indicators meet criteria they can assure that means measurement invariance across observed groups is held, while residual restrain model may be too critical to be reached. Tabachnick and Fidell also suggest that when factor loadings and factorial covariance are equivalent across group it is indicated that measurement invariance holds true.
The purpose of study 6 was to examine the predictive validity of the 6-factor, item AMES. With an expected off ratio of 2. The participants completed the demographic questionnaire and six-factors, item AMES a day before the championship. Then, after completion of the championship, we collected their competition records of medals. In this study, winning a medal in the competition was considered as successful performance outcome.
The general procedures i. The measures included the demographic questionnaire and the six-factors, item AMES. We used SPSS Specifically, we used logistic regression to examine whether AME predicted winning medals Harrell, Firstly, simple logistic regression was used to examine the association between individual independent variables with the dependent variables Medal and non-Medal. Then multiple logistic regression was used to determine the significant independent variables in the binary logistic regression model.
Table 8 shows the simple and multiple logistic regression results of the associations between total score and subscale of AMES and the outcome of medal and non-medal recipients. The results showed that AMES was associated with the outcome of medal and non-medal. Specifically, an increase in 1 unit score of AMES was associated with 1. Also, the results of multiple logistic regression with the subscales of AMES showed that confidence, motivation, tireless, and calm were associated with the medal and non-medal outcome.
A person with an increase in 1 unit score in confidence has 2. An increase in 1 unit score in motivation had 1. And, an increase in 1 unit score in calm had a 1. Table 8. Factors associated with total score and subscales of AMES with medal and non-medal. The purpose of study 6 was to examine the predictive validity of the six-factors, items AMES with Malaysian University Chinese martial artists.
Logistic regression results showed total AMES and four factors of AME-confidence, motivation, tireless, and calm predicted medal winning. Thus, the predictive validity of the 6-factor, items AMES was supported. Specifically, across five studies, we found a 6-factor, item AMES had appropriate content validity, factor structure, convergent validity, discriminant validity, predictive validity, and reliability. Our study found that AME comprises 6 factors: vigor, motivation, confidence, tireless, concentration, and calm. The factor of motivation is similar to ILSI framework, but our study found three factors i.
Further, our study found another two factors—self-confidence and concentration to replace the ILSI framework of cognition. Thus, our study is in line with the ILSI framework but creates a unique model of mental energy specific to the sport. The strength of this study was in adopting existing ILSI framework for mental energy and taking an empirical approach to produce a reliable and valid sport-specific mental energy scale.
Our study followed The Standards for Educational Psychological Testing suggestions for developing a measure of an individuals' knowledge, skills, abilities, interests, attitudes, or other characteristics American Educational Research Association, American Psychological, Association, and National Council on Measurement in Education, , p. We designed and followed a specific plan through six studies from the qualitative exploration of AME to psychometric testing of measurement validity and reliability.
With this approach, we believe we have improved existing mental energy measures such as Kennedy et al. The AMES is the first measure of mental energy in sports and psychology with sufficient reliability and validity. By this tool, researchers can not only help researchers to examine what factors lead to AME but also examine how AME influence athletes' cognition, emotion, and performance. Also, our preliminary work on AME has several theoretical implications for researchers.
The affective components i. Olympic rowing, swimming, and wrestling candidates and found successful athletes scored high on vigor but low on anxiety, fatigue, depression, anger, and confusion compared to unsuccessful athletes. Similarly, the calm factor of AME also supports Ravizz's findings that athletes reported they had no fear of loss, and feeling physically mentally relaxed when they performed their best.
Further, Loehr found athletes who performed extraordinarily well-experienced seeming controlled by competition, full of energy but in an easy manner. Recently, Fletcher and Sarkar investigated resilience in Olympic gold medalists found Olympic champions possess several unique characteristics such as open to new experiences, emotional stable, and optimistic.
The calm and relaxation experiences are also frequently found in flow research e. When individuals experience flow they reported sensations of relaxation, calm, and effortless. Thus, the affective components of AME seemed linking to peak performance experiences and flow.
The cognitive components i. Self-confidence represents athletes' beliefs about whether they can accomplish the task Vealey and Chase, Literature has demonstrated a consistent relationship between high levels of confidence and successful sporting performance Feltz et al. Past research on peak performance found when athletes were playing their best they are highly confident with no fear of failure e.
Also, when performing their best athletes reported that they were totally concentrated, with a narrow focus of attention on the present, immersed in the activity, and completely in control while acting. In a recent study on the optimal psychological state for peak performance, Anderson et al. Thus, the cognitive components of AME coincide with the findings in peak performance research.
The component of motivation in AME is relevant to sport psychology. It is estimated that one-third of all studies in sport psychology deal with motivation in one form or another Roberts, The motivation component in AME mostly refers to athletes' expectation and goals in sports e. Thus, it is suggested that AME would influence athletes' investment in sports training and competition. Those low in AME would be expected to be low in sports engagement e. Therefore, it is likely that any motivational intervention e. However, further research is needed to confirm these inferences. The nomological validity findings provide information for researchers and practitioners.
Specifically, we found AME positively correlated with the positive state of mind. According to Horowitz et al. Hence, it is implied that athletes high in AME would be high in the positive state of mind. In contrast, we found AME negatively correlated with athletic burnout and life stress. Past research indicated that athletes high in positive psychological attributes—such as self-confidence e.
Hence, the present study not only supports past research on the relationship between athletes' positive attributes and burnout but also suggests AME has an influence on burnout. The predictive validity findings have several theoretical implications. To the best of our knowledge, this is the first study examining how AME predicts athletic performance. For a long time, sport psychology researchers have been interested in psychological profiles that predict athletic performance.
The present study adds to this literature and suggests that AME predicts athletic performance. However, only four factors -confidence, motivation, tireless, and calm were the significant predictors of martial artists' success. The factors of confidence, motivation, tireless, and calm support past research on peak performance e.
Our study had several limitations. First, although we used a qualitative approach to establish an initial framework of AME, our study only offers a preliminary framework and future study is needed. We suggest future adopting the same approach of the present study and exploring the potential model of AME. Second, our participants were all recruited from Taiwan and Malaysia, and the participants are mostly Asians. Therefore, AME needs to be examined in different continents and cultures.
Further, the samples were all college student-athletes, and our results can't be generalized to professional athletes or younger athletes. Furthermore, since the AMES is a state-like measure it is very sensitive to situational and contextual factors Rule and Traver, ; Jacobs et al, we did not examine its test-retest reliability. We suggest future study may examine the fluctuation of AME to examine its relationship with environmental and personal factors. Moreover, on Study 3 we used college student-athletes as our participants to perform EFA.
Though it is acceptable in related literature. For example, Hair et al. However, Comrey and Lee suggested that sample size as is poor, is fair, as good, as very good, and 1, or more as excellent. We suggest future study should recruit more participants when performing EFA. We suggest that future research may validate the 6-factor, item AMES in different cultures. Another line of future research might examine the antecedents and consequences of mental energy. For example, supplements of sucromalt e. Whether these supplements also increase AME needs further examination.
In addition, we suggest future study may examine what psychological skill training increases AME. In particular, recent studies found mindfulness training increases athletes' concentration and confidence e. Therefore, whether mindfulness training also enhances AME needs further examination. Further, research suggested that insufficient sleep influences athletes' memory, cognition, and performance Halson, Thus, whether insufficient sleep also influences AME can be another direction for researchers.
Moreover, we suggest future study may examine the associations of AMES and other sports behavior such as coach-athlete relationship Jowett and Poczwardowski, , sport confidence Beaumont et al. Further, through 6 studies we have established the preliminary psychometric properties of the 6-factor, item AMES by examining the content validity, factor validity factorial structure, nomological validity, discriminant validity, predictive validity, measurement invariance, and reliability, there are remaining many spaces for future researchers to examine the underlying psychometric properties of AMES.
For example, future research may compare the group differences between high and low-performance athletes to establish predictive validity. Also, researchers may conduct a laboratory or filed experiment to examine how AME influence athletic performance to examine construct validity of the 6-factor, item AMES. Moreover, researchers may adopt a cross-cultural approach to examine the factorial validity, construct validity, and predictive validity in different cultures. In terms of application, we suggest coaches or sport psychology consultants may use this 6-factor, item AMES to monitor athletes' training loadings and AME.
Research suggests that excessive training loads increase athletes' anger, anxiety, depression, and fatigue Raglin et al. Therefore, coaches or sport psychology consultants might use AMES to monitor athletes' training status to help athletes with appropriate training. In a similar way, coaches or sports scientists may use AMES to monitor athletes' training loadings in pre-season or in-season Jeong et al. Specifically, the AMES can help coaches or sports scientists understand whether changes in training loadings influence athletes' mental energy.
Further, it is recommended that sport psychology consultants may use AMES to assess athletes' mental strength and weakness before conducting a psychological skills training PST Weinberg and Williams, , p. We think this is just a starting point of the AME research in sports settings. We hope our study inspires more research on this issue, not only for the pursuit of knowledge but also for the exploration of psychological factors underlying sport excellence.
All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Standards for Educational Psychological Testing. Washington, DC. Anderson, R. Investigating the optimal psychological state for peak performance in Australian elite athletes.
Sport Psychol. Barbosa-Leiker, C. Is the assessment of the metabolic syndrome stable over time? Testing longitudinal measurement invariance of the metabolic syndrome. Barbuto, J. Mental energy: assessing the motivation dimension. Beaumont, C. Effective ways to develop and maintain robust sport-confidence: strategies advocated by sport psychology consultants. Bentler, P. Encino, CA: Multivariate software. Chang, Y. Sport Exerc. Chen, F. Sensitivity of goodness of fit indexes to lack of measurement invariance. Testing measurement invariance of second-order factor models.
Cheung, G. Evaluating goodness-of-fit indexes for testing measurement invariance. Child, D. The Essentials of Factor Analysis, 3rd Edn. New York, NY: Continuum. Google Scholar. Chyi, T. Prediction of life stress on athletes's burnout: the dual role of perceived stress. Comrey, A. Cook, D. Mental energy: defining the science. Csikzentmihalyi, M. Flow: The Psychology of Optimal Experience.
Dammann, K. Effects of consumption of sucromalt, a slowly digestible carbohydrate, on mental and physical energy questionnaire responses. Durand-Bush, N. Elo, S. The qualitative content analysis process. Federici, R. Principal self-efficacy: relations with burnout, job satisfaction and motivation to quit.
Feltz, D. Champaign, IL: Human Kinetics. Fletcher, D. A grounded theory of psychological resilience in Olympic champions. Fornell, C. Evaluating structural equation models with observable variables and measurement error. Mark Res. Garfield, C. Los Angeles, CA: Tarcher. Giancoli, D. Physics for Science and Engineers. London: Pearson Education, Ltd. Gorsuch, R. Factor Analysis, 2nd Edn. Gustafsson, H. The mediational role of perceived stress in the relation between optimism and burnout in competitive athletes.
Anxiety Stress Cop. Hope and athlete burnout: stress and affect as mediators. Hair, J. Multivariate Data Analysis, 5th Edn. Halson, S. Sleep in elite athletes and nutritional interventions to enhance sleep. Six years later, more than clinical trials, with nearly half being RCTs, have consistently shown EFT to produce positive clinical outcomes available from the online database maintained at www. The approach has also been the subject of more than 40 peer-reviewed concept papers and systematic reviews which have established it as an evidence-based treatment for a range of disorders [ 42 ].
Emotion Freedom Techniques had a large treatment effect compared to control groups who received standard care, produced equivalent outcomes to other evidence-based therapies—specifically CBT and EMDR—and its effect sizes exceeded those of psychopharmacological interventions. This group of studies found that the treatment time frame required to remediate PTSD ranged from 4 to 10 sessions [ 45 ].
The efficacy of EFT for PTSD has been investigated in a variety of populations, including war veterans, victims of sexual violence, the spouses of PTSD sufferers, motor accident survivors, prisoners, hospital patients, adolescents, and survivors of natural and human-caused disasters [ 42 ]. The clinical outcomes demonstrated in the literature appear to be generalizable to a wide variety of populations and settings. A core clinical dilemma when treating PTSD is that traumatic memories need to be addressed and processed in order for recovery to occur, but approaching these memories runs the risk of re-traumatization and resulting exacerbation of symptoms [ 47 , 48 , 49 ].
Moreover, traumatic memories are stored differently from autobiographical memory, being more in the form of sensory-motor reliving of the traumatic experience, and often in an unintegrated mode that is not yet mediated via language [ 17 , 50 ]. Clinical EFT contains inherent procedural elements that are designed to minimize the danger of re-traumatization by approaching the traumatic memory in graduated steps and reducing arousal at each step, making EFT unusually gentle and safe.
The approach leads clients into a position from which the traumatic memory can be narrated without emotional distress. In addition to individual treatment sessions, group EFT has also been found to be effective [ 52 ]. Several studies show that Borrowing Benefits produces significant clinical gains in participants [ 53 , 54 , 55 ]. For instance, in a study of veterans and their spouses, PTSD symptomology was evaluated before and after a seven-day retreat in which group sessions that utilized Borrowing Benefits were one of the core therapeutic activities [ 55 ].
In a study of individuals suffering from fibromyalgia, participants were treated entirely online using an EFT protocol [ 56 ]. Significant improvements were found in anxiety, depression, and pain. Another study compared EFT delivered via face-to-face sessions with EFT delivered via telephone with a group of veterans reporting clinical symptoms that fall above the PTSD threshold [ 57 ]. In contrast, six of the seven studies they reviewed of EFT treatments for PTSD exceeded each of these effect sizes, and all seven showed a large effect.
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In any case, the preliminary evidence from online and telephone applications of EFT indicates that psychological improvement appears to result from such remote interventions. Battle Tap allows veterans to log on and conduct tapping sessions at the time and place of their choosing and with complete anonymity. After entering the site, they describe their concerns, which the software then integrates into a customized Setup Statement. They are then guided via video sessions recorded with other veterans in which they use Borrowing Benefits to reduce PTSD symptoms.
Post-traumatic stress disorder is typically comorbid with other diagnoses, most often depression, anxiety, substance dependence or abuse, or chronic pain [ 15 ]. Emotion Freedom Technique studies examining the relationships among PTSD and co-morbid conditions have found that reductions in PTSD symptoms correlate with reductions in anxiety, depression, and pain [ 54 , 59 ]. When veterans have been successfully treated for PTSD, levels of traumatic brain injury TBI symptoms have also been reduced [ 60 , 61 ]. Emotion Freedom Technique group treatments of PTSD using the Borrowing Benefits method also found simultaneous reductions in depression and anxiety [ 53 , 54 ].
Elevated PTSD symptoms, even if subclinical, have been shown to be a risk factor for a later diagnosis of PTSD as well as depression, alcohol abuse, and health problems [ 62 , 63 ]. Emotion Freedom Techniques have been employed as a pre-emptive measure to treat symptoms early, enhance resiliency, and arrest the progression of the diagnosis. In one study, 21 veterans with elevated but subclinical scores on a standardized PTSD measure were no longer in the elevated range after six EFT sessions [ 62 ].
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Participant gains were durable, with non-elevated scores maintained at follow-up periods of three and six months. In terms of physiological impact and benefits, EFT has been shown to a reduce levels of stress hormones such as cortisol; b diminish symptoms such as pain and traumatic brain injury; c produce an epigenetic effect on the expression of stress genes; and d improve general markers of health such as resting heart rate, blood pressure, and immunoglobulin. A preliminary set of guidelines for treating PTSD with Clinical EFT was derived from a detailed practitioner survey, a review of empirical evidence, and a study of case histories [ 58 ].
The survey was distributed by professional groups whose members utilize EFT in the U. Responses were received from practitioners. These organizations included, in the U. This model recommends offering the least intrusive and potentially most effective intervention for PTSD treatment first. If a patient fails to benefit from this first step, the next and potentially more intrusive treatment is recommended. Only if these initial steps fail are more intrusive methods such as psychopharmacology and intensive psychotherapy advocated. Assessments routinely involve taking a psychiatric history and inquiry into co-morbid conditions, addiction, alcohol dependence, physical health conditions, availability of social and family support, housing and other material circumstances.
The information gathered may dictate referral to additional agencies. For individuals who do not adequately respond to the first two steps, the NICE guidelines recommend drug treatment as the third step. The treatment protocol includes five sessions of Clinical EFT for patients who are at risk as evidenced by subclinical PTSD scores and 10 sessions for patients above the clinical cutoff. The recommendation of 10 sessions is the most conservative in the range identified for effective treatment i.
These sessions are in addition to treatment as usual. Acupoint tapping can be safely used by clients on a self-help basis, and it is generally taught for managing elevated emotions between sessions. The Guidelines also recommend that clients be offered supplementary resources, including access to online services such as Battle Tap and other tutorials as well as access to social support such as Borrowing Benefits groups that include spouses and other family members.
A third step in treatment intensity is applied with individuals who still suffer with PTSD symptoms following the first two steps. The third step may also be immediately applied for individuals with PTSD combined with a history of developmental trauma. The Clinical Guidelines are summarized in Table 1. The PCL can be administered immediately before or after each session to monitor changes in symptomology. The use of the PCL-4 in the Guidelines is to indicate symptom severity and does not preclude the use of other instruments or the PCL-5 when more research on that version is available.
The representatives of the major organizations involved with EFT who helped formulate and refine these Guidelines recommended several additional considerations and cautions for applying them.
In clinical trials, practitioners are required to deliver a method as described in a written treatment manual, and fidelity to that manual is typically monitored by investigators. This strict adherence to a manualized method is a customary standard in research since it ensures that the method, as tested in one study, is the same method tested in another.
However, such formulaic applications of a technique are unusual in clinical practice, especially with experienced practitioners. Clinicians are oriented toward patient well-being and will change and combine methods based on their perceptions of what will work best for the client [ 7 ]. Most innovations in both psychology and medicine are due to curious practitioners who tried something new in a challenging client situation [ 33 ].
In most settings, clinicians have wide latitude over the type of treatment employed, provided it is evidence-based. While the Guidelines are consistent with the published literature and expert opinion, they are only guidelines. Guidelines are useful to determine a probable course of treatment, but in practice they may be and should be modified by the clinician—client by client and session by session.
It has been hypothesized that the presence of developmental trauma, which was not factored into the research designs, may have been a contributing factor for the non-responders [ 51 ]. This type of neurologically formative traumatic experience is believed to shape neural circuitry to a degree that is fundamental to subsequent development [ 17 ]. The success of EFT in treating PTSD suggests that it could also be effective with complex personality and relational difficulties that are rooted in childhood trauma [ 49 , 71 , 72 ].
Clinical EFT includes nonverbal somatic procedures, and since developmental trauma is coded non-verbally and may even occur before the acquisition of language, these are likely to be more helpful than primarily cognitive methods. During initial assessment, developmental trauma in clients presenting with clinical PTSD should be noted as a possible factor which might require the treatment to be oriented around the third step specified in the Guidelines.
Because the basic EFT protocol is relatively easy to learn, uncertified, unqualified practitioners have occasionally used it without preliminary assessment of possible psychiatric diagnoses, leading to unfortunate outcomes. While EFT has been successfully applied in the treatment of PTSD by allied care providers such as qualified life coaches [ 73 ], mastery in the topics covered in existing EFT practitioner training programs is essential for responsible application.
The primary organizations certifying practitioners in EFT require a thorough curriculum-based educational program prior to certification. This academic and practice-based training is oriented toward instilling a deep understanding of the essential principles of EFT and developing a core set of skills for its application. These principles and skills are integrated with other pertinent areas of psychological, psychotherapeutic, and neurobiological knowledge. Practice sessions are evaluated and guidance is provided. Ethical issues that can arise in the practice of EFT are explored.
If the training is oriented toward individuals who are not already licensed mental health professionals, additional components include recognition of serious psychiatric disorders, the appropriate use of referrals, and other scope of practice issues. In addition, membership in one of the EFT professional organizations, with their detailed codes of ethics, is strongly advised to program graduates. Release forms should be signed early when treating PTSD. With millions of people having downloaded EFT self-help guides or participated in online trainings over the past quarter-century, the consensus among those teaching people to use EFT on this basis is that the approach is safe and consistently reduces emotional distress [ 42 ].
Practitioners routinely teach EFT to clients early in the therapy and recommend that they use it whenever distressing everyday events occur. Unless cost-effective therapies are implemented rapidly, the estimated cost to the US economy of PTSD in veterans alone could exceed a trillion dollars [ 63 ]. If widely adapted, Clinical EFT promises to be such a cost-effective, evidence-based treatment.
Combining acupressure with elements derived from cognitive and exposure therapies, EFT has been validated in more than clinical trials and has demonstrated efficacy for a range of populations and psychological conditions. Treatment effects have equaled or exceeded those obtained from pharmacological interventions and conventional psychotherapy.
After completion of a high quality yet relatively succinct certification program, it can be responsibly applied in individual or group settings by licensed psychotherapists, allied health care professionals, or qualified life coaches. Five EFT sessions are recommended for subclinical PTSD symptomology, 10 sessions for clinical PTSD, and intensive psychotherapy or psychopharmacology or both for non-responsive patients or those with a history of developmental trauma.
In addition, family support, group EFT utilizing the Borrowing Benefits approach, and online resources may be recommended as adjuncts to individual sessions. The following contributions were made by each author: conceptualization, D. The Dreamscience Foundation and the Tapping Solution Foundation provided funding for the drafting of this paper. Authors Boath, Church, Feinstein, MacKay, Mollon, and Stapleton derive income from publications and presentations related to the technique described.
About the Journal
National Center for Biotechnology Information , U. Journal List Healthcare Basel v. Healthcare Basel. Published online Dec E Find articles by Elizabeth Boath. Author information Article notes Copyright and License information Disclaimer. Received Oct 24; Accepted Dec 7. Abstract Clinical EFT Emotional Freedom Techniques is an evidence-based method that combines acupressure with elements drawn from cognitive and exposure therapies. The Nature and Treatment of PTSD Post-traumatic stress disorder symptoms include flashbacks, nightmares, intrusive thoughts, severe anxiety, hypervigilance, sleep disturbance, physical aggression, and poor concentration.
Prognosis A review of longitudinal studies published between and found that in populations exposed to trauma, a mean of Diagnosis and Assessment While definitive biological tests are currently unavailable to assist in the diagnosis and assessment of PTSD, checklists and interviews exploring PTSD symptomology have been developed and validated to assist in confirming PTSD diagnoses. Delayed-Onset PTSD Post-traumatic stress disorder symptoms sometimes do not appear until months after the traumatizing event. Conventional PTSD Treatments Biological as well as psychological factors contribute to the development and maintenance of PTSD symptomology, and both pharmacological and psychological interventions have been shown to significantly reduce PTSD symptomology [ 8 ].
Pharmacological Most of the research into pharmacological treatments for PTSD has focused on selective serotonin reuptake inhibitors SSRIs , which have been found to produce a broad effect on PTSD symptoms, including reductions in avoidance behavior, hyperarousal, and intrusive re-experiencing of the event [ 21 ]. Psychological Exposure-oriented behavioral interventions are frequently used in the treatment of PTSD.
Clinical EFT Developed in the early s, Clinical EFT is a psychophysiological intervention which combines psychological methods drawn from conventional therapies with somatic stimulation. Changes in Biological Markers Following EFT Treatments As might be expected from a therapy that includes a strong somatic component, measurable changes in biological markers have been found following EFT treatments. Efficacy Evidence demonstrating the effectiveness of EFT and other acupoint psychotherapies has steadily increased in recent years.
Populations that Respond The efficacy of EFT for PTSD has been investigated in a variety of populations, including war veterans, victims of sexual violence, the spouses of PTSD sufferers, motor accident survivors, prisoners, hospital patients, adolescents, and survivors of natural and human-caused disasters [ 42 ]. Safety A core clinical dilemma when treating PTSD is that traumatic memories need to be addressed and processed in order for recovery to occur, but approaching these memories runs the risk of re-traumatization and resulting exacerbation of symptoms [ 47 , 48 , 49 ].
Group Treatment In addition to individual treatment sessions, group EFT has also been found to be effective [ 52 ]. Online, App, and Telemedicine Treatment Sessions In a study of individuals suffering from fibromyalgia, participants were treated entirely online using an EFT protocol [ 56 ]. Simultaneous Treatment of PTSD and Comorbid Conditions Post-traumatic stress disorder is typically comorbid with other diagnoses, most often depression, anxiety, substance dependence or abuse, or chronic pain [ 15 ].
Prevention and Resilience Elevated PTSD symptoms, even if subclinical, have been shown to be a risk factor for a later diagnosis of PTSD as well as depression, alcohol abuse, and health problems [ 62 , 63 ]. PCL-4 Score above 50 PTSD range 2nd Step: Treatment as usual plus 10 individual EFT therapy sessions; two instructional consultations on utilizing the Battle Tap interactive online coach; Borrowing Benefits group therapy sessions, inviting the spouse or other family members, may be recommended.
Open in a separate window. Applying the Guidelines The representatives of the major organizations involved with EFT who helped formulate and refine these Guidelines recommended several additional considerations and cautions for applying them. Practitioner Discretion In clinical trials, practitioners are required to deliver a method as described in a written treatment manual, and fidelity to that manual is typically monitored by investigators.
Unqualified Practitioners Because the basic EFT protocol is relatively easy to learn, uncertified, unqualified practitioners have occasionally used it without preliminary assessment of possible psychiatric diagnoses, leading to unfortunate outcomes. Self-Help Applications With millions of people having downloaded EFT self-help guides or participated in online trainings over the past quarter-century, the consensus among those teaching people to use EFT on this basis is that the approach is safe and consistently reduces emotional distress [ 42 ]. Conclusions Unless cost-effective therapies are implemented rapidly, the estimated cost to the US economy of PTSD in veterans alone could exceed a trillion dollars [ 63 ].
Author Contributions The following contributions were made by each author: conceptualization, D.
Funding The Dreamscience Foundation and the Tapping Solution Foundation provided funding for the drafting of this paper. Conflicts of Interest Authors Boath, Church, Feinstein, MacKay, Mollon, and Stapleton derive income from publications and presentations related to the technique described. References and Note 1. Kessler R. Shalev A. Post-traumatic stress disorder. Posttraumatic stress disorder in the National Comorbidity Survey. Steenkamp M. Eftekhari A. Effectiveness of national implementation of prolonged exposure therapy in veterans affairs care.
JAMA Psychiatry. Alexander W. Pharmacotherapy for post-traumatic stress disorder in combat veterans: Focus on antidepressants and atypical antipsychotic agents. Lancaster C. Posttraumatic stress disorder: Overview of evidence-based assessment and treatment.
Guidelines for the Treatment of PTSD Using Clinical EFT (Emotional Freedom Techniques)
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